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Shaji K. Kumar, MD

Prashant Kapoor, MD, FACP


Can MGUS Status Predict the Progression of Multiple Myeloma?

By: Vanessa A. Carter, BS
Posted: Friday, May 6, 2022

Florentin Späth, MD, PhD, of the Oncology and Cancer Center, Umeå University, Sweden, and colleagues conducted a study to determine whether progression from low-risk monoclonal gammopathy of undetermined significance (MGUS) is associated with worse outcomes in patients with multiple myeloma. Published as a Letter to the Editor in Experimental Hematology & Oncology, the results of their trial suggest that although patients who are at low risk for MGUS are less likely to develop multiple myeloma, many may experience disease progression and develop more aggressive tumors.

“Until ongoing studies provide answers, our data stress the need for improved MGUS stratification based on specific molecular features rather than biomarkers largely reflective of tumor burden,” the study authors concluded. “Investigation of microenvironmental differences in prospective blood samples among stable and progressing MGUS could help increase the understanding of underlying extrinsic factors in multiple myeloma progression and identify useful biomarkers.”

The MGUS status of 42 patients with multiple myeloma was retrospectively determined using repeated, prediagnostic blood samples at a median of 11.6 and 3.3 years before myeloma diagnosis. Low-risk MGUS was defined by an immunoglobulin G monoclonal spike of less than 15 g/L and a normal free light-chain ratio.

At the first prediagnostic blood draw, 12 of 42 patients had MGUS of low risk; 30 had MGUS of other risk. Of note, multiple myeloma–related bone disease was more prevalent in patients with low-risk MGUS at first blood draw compared with those of other risk (67% vs. 30%; P = .041). Furthermore, the median survival since myeloma diagnosis was significantly worse in participants with low-risk MGUS versus other risk scores at first blood draw (2.3 vs. 7.5 years; P = .004). Approximately 67% of individuals remained with low-risk or low-intermediate–risk MGUS at the repeated blood draw, and modest disease progression was reported among first and repeated draws for most patients with low-risk MGUS.

Disclosure: The study authors reported no conflicts of interest.

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